Search

Background: The training of peer supporters is critical because the success of the entire peer support intervention depends on the knowledge and experience that peer supporters can share with other patients. The objective of this study was to evaluate the pilot implementation of a specialist nurse-led self-management training programme for peer supporters with type 2 diabetes mellitus (T2DM) with or without comorbid hypertension (HTN) at the primary healthcare level in Slovenia, in terms of feasibility, acceptability, and effectiveness. Methods: A prospective pre-post interventional pilot study was conducted in two Community Health Centres (CHC) in Slovenia from May 2021 to August 2022. Purposive sampling was employed to recruit approximately 40 eligible volunteers to become trained peer supporters. A specialist nurse-led structured training lasting 15 h over a 2-month period was delivered, comprising four group and two individual sessions. The comprehensive curriculum was based on interactive verbal and visual learning experience, utilising the Diabetes Conversation Maps™. Data were collected from medical records, by clinical measurements, and using questionnaires on sociodemographic and clinical data, the Theoretical Framework of Acceptability, knowledge of T2DM and HTN, and the Appraisal of Diabetes Scale, and evaluation forms. Results: Of the 36 participants, 31 became trained peer supporters (retention rate of 86.1%). Among them, 21 (67.7%) were women, with a mean age of 63.9 years (SD 8.9). The training was evaluated as satisfactory and highly acceptable. There was a significant improvement in knowledge of T2DM (p < 0.001) and HTN (p = 0.024) among peer supporters compared to baseline. Six months post-training, there was no significant improvement in the quality of life (p = 0.066), but there was a significant decrease in body mass index (BMI) (p = 0.020) from 30.4 (SD 6.2) at baseline to 29.8 (SD 6.2). Conclusion: The pilot implementation of a specialist nurse-led self-management training for peer supporters was found to be feasible, acceptable, and effective (in the study group). It led to improvements in knowledge, maintained disease control, and promoted positive self-management behaviours among peer supporters, as evidenced by a decrease in their BMI over six months. The study emphasises the need for effective recruitment, training, and retention strategies. Trial registration: The research is part of the international research project SCUBY: Scale up diabetes and hypertension care for vulnerable people in Cambodia, Slovenia and Belgium, which is registered in ISRCTN registry (https://www.isrctn.com/ISRCTN41932064). [ABSTRACT FROM AUTHOR]

Patient empowerment is crucial for promoting and strengthening health. We aimed to assess patient empowerment and diabetes-specific health-related quality of life (HRQoL) in adults with type 2 diabetes (T2D). A multi-centre, cross-sectional survey was conducted among adults with T2D in urban and rural primary care settings in Slovenia between April and September 2023. The survey utilised convenience sampling and included sociodemographic and clinical data, the Diabetes Empowerment Scale (DES), and the Audit of Diabetes-Dependent QoL (ADDQoL). The study included 289 people with T2D and a mean age of 67.2 years (SD 9.2). The mean overall DES score was 3.9/5 (SD 0.4). In a multivariable linear regression model, higher empowerment was significantly associated with residing in a rural region (p = 0.034), higher education (p = 0.028), and a lack of comorbid AH (p = 0.016). The median overall ADDQoL score was −1.2 (IQR [−2.5, −0.6]). The greatest negative influence of diabetes on HRQoL was observed in the domain 'Freedom to eat', followed by 'Freedom to drink', 'Leisure activities', and 'Holidays'. Despite high empowerment among adults with T2D, the condition still imposes a personal burden. Integrated primary care models should prioritise the importance of implementing targeted interventions to enhance diabetes empowerment, address comorbidities, and improve specific aspects of QoL among individuals with T2D. [ABSTRACT FROM AUTHOR]

Background: Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation. Methods: Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program. Results: We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful. Conclusion: Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team. [ABSTRACT FROM AUTHOR]

Introduction: Research on models of integrated health care for hypertension and diabetes is one of the priority issues in the world. There is a lack of knowledge about how integrated care is implemented in practice. Our study assessed its implementation in six areas: identification of patients, treatment, health education, self-management support, structured collaboration and organisation of care. Methods: This was a mixed methods study based on a triangulation method using quantitative and qualitative data. It took place in different types of primary health care organisations, in one urban and two rural regions of Slovenia. The main instrument for data collection was the Integrated Care Package (ICP) Grid, assessed through four methods: 1) a document analysis (of a current health policy and available protocols; 2) observation of the infrastructure of health centres, organisation of work, patient flow, interaction of patients with health professionals; 3) interview with key informants and 4) review of medical documentation of selected patients. Results: The implementation of the integrated care in Slovenia was assessed with the overall ICP score of 3.7 points (out of 5 possible points). The element Identification was almost fully implemented, while the element Self-management support was weakly implemented. Discussion: The implementation of the integrated care of patients with diabetes and/ or hypertension in Slovenian primary health care organisations achieved high levels of implementation. However, some week points were identified. Conclusion: Integrated care of the chronic patients in Slovenia is already provided at high levels, but the area of self-management support could be improved. [ABSTRACT FROM AUTHOR]

Background: Independence in daily activities is defined as the ability to perform functions related to daily living, i.e. the capacity of living independently in the community with little or no help from others. Objective: We focused on non-attenders as a subgroup of patients whose health status is not well known to family practice teams. Our goal was to estimate the prevalence of dependence and its severity level in the daily activities of patients, and to determine the factors that are associated with the occurrence of dependence. Design: Cross-sectional observational study. Settings and participants: Data was obtained in family medicine settings. Participants in the study were adults living in the community (aged 18 or over) who had not visited their chosen family physician in the last 5 years (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2,025 non-attenders. Community nurses collected data in the participants' homes. The outcome measure was dependence in daily activities, assessed through eight items: personal hygiene; eating and drinking; mobility; dressing and undressing; urination and defecation; continence; avoiding hazards in the environment; and communication. Results: The final sample consisted of 1,999 patients (98.7% response rate). The mean age was 59.9 (range 20 to 99). Dependence in daily activities was determined in 466 or 23.3% (95% CI: [21.5, 25.2]) of the patients. Older patients (over 60 years), with at least one chronic disease, increased risk of falling, moderate feelings of loneliness and a lower self-assessment of health were statistically significantly more likely to be dependent in their daily activities, according to our multivariate model. Conclusions: A considerable proportion of family practice non-attenders were found to be dependent in daily activities, though at a low level. We identified several factors associated with this dependence. This could help to identify people at risk of being dependent in daily activities in the general adult population, and enable specific interventions that would improve their health status. [ABSTRACT FROM AUTHOR]

Management of emergencies is an integral part of primary care. However, the wide range of symptoms and the rarity of the situations make it difficult for primary care workers to be continually updated and competent in providing life support. In Ljubljana Community Health Centre, we use innovative approaches and modern teaching techniques to educate primary health care teams on how to manage medical emergencies. The three-level educational approach described here enables comprehensive education in managing and recognising dangerous medical situations. It also provides a safe way of learning how to manage difficult, uncommon and serious clinical situations. This comprehensive educational approach is oriented towards continuous improvement in quality and the safety of patients at the primary health care level. [ABSTRACT FROM AUTHOR]

Health systems worldwide struggle to manage the growing burden of type 2 diabetes and hypertension. Many patients receive suboptimal care, especially those most vulnerable. An evidence-based Integrated Care Package (ICP) with primary care-based diagnosis, treatment, education and self-management support and collaboration, leads to better health outcomes, but there is little knowledge of how to scale-up. The Scale-up integrated care for diabetes and hypertension project (SCUBY) aims to address this problem by roadmaps for scaling-up ICP in different types of health systems: a developing health system in a lower middle-income country (Cambodia); a centrally steered health system in a high-income country (Slovenia); and a publicly funded highly privatised health-care health system in a high-income country (Belgium). In a quasi-experimental multi-case design, country-specific scale-up strategies are developed, implemented and evaluated. A three-dimensional framework assesses scale-up along three axes: (1) increase in population coverage; (2) expansion of the ICP package; and (3) integration into the health system. The study includes a formative, intervention and evaluation phase. The intervention entails the development and implementation of an improved scale-up strategy through a roadmap with a minimum dataset to monitor proximal and distal outcomes. The SCUBY project is expected to result in three different roadmaps, tailored to the specific health system and country context, to progress scale-up of the ICP along three dimensions. These roadmaps can be adapted to other health systems with similar typology. Implementation is expected to increase the number of well-controlled patients with type 2 diabetes and hypertension in Cambodia, to reduce inequities in care and increase patient empowerment in Belgium and Slovenia. [ABSTRACT FROM AUTHOR]

Patients that cannot come to their family medicine practice (i.e. who have difficulties with access) do not receive the same preventive screening activities and management of their chronic diseases as those who can. Community nurses who provide healthcare to patients in their homes were trained in additional competencies, including screening for risk factors for selected diseases and the management of patients with selected chronic diseases. The presented model enables equal management of all registered patients, regardless of accessibility. It also fosters exchange of information within the team members and thus improves the quality of the team management of patients. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the possible associations between higher levels of selected quality indicators and the characteristics of providers. Background In 2011, an ongoing project on a new model of family medicine practice was launched in Slovenia; the family physicians' working team (a family physician and a practice nurse) was extended by a nurse practitioner working 0.5 full-time equivalents. This was an example of a personalised team approach to managing chronic patients. Methods We included all family medicine practices in the six units of the Community Health Centre Ljubljana which were participating in the project in December 2015 ( N = 66). Data were gathered from automatic electronic reports on quality indicators provided monthly by each practice. We also collected demographic data. Results There were 66 family medicine teams in the sample, with 165 members of their teams (66 family physicians, 33 nurse practitioners and 66 practice nurses). Fifty-six (84.4%) of the family physicians were women, as were 32 (97.0%) of the nurse practitioners, and 86 (95.5%) of the practice nurses. Multivariate analysis showed that a higher level of the quality indicator 'Examination of diabetic foot once per year' was independently associated with nurse practitioners having attended additional education on diabetes, duration of participation in the project, age and years worked since graduation of nurse practitioners, working in the Center unit and not working in the Bezigrad unit. Conclusions Characteristics of team members are important in fostering quality management of chronic patients. Nurse practitioners working in new model family practices need obligatory, continuous professional education in the management of chronic patients. Relevance to clinical practice The quality of care of chronic patients depends on the specific characteristics of the members of the team, which should be taken into account when planning quality improvements. [ABSTRACT FROM AUTHOR]

Aims: To examine the present state of health-related quality of life (HRQOL) among elderly individuals with type 2 diabetes (T2D) receiving integrated care and identify risk factors associated with low HRQOL., Methods: A multi-centre cross-sectional survey among elderly individuals with T2D, treated in Slovenian urban and rural primary care settings was performed. HRQOL was investigated using EuroQol 5-dimension (EQ-5D) questionnaire and Appraisal of Diabetes Scale (ADS). Furthermore, socio-demographic, clinical, and laboratory data were collected. Low HRQOL was defined as EQ-5D utility score <10%. Statistical analysis was performed using univariate and multivariate binary logistic regression statistics., Results: Examining 358 people with median age of 72 (range 65-98) years and with a mean EQ-5D utility score of 0.80, the study found that lower HRQOL correlated with older age, higher body mass index (BMI), lower education, elevated depressive symptoms, increased challenges across all EQ-5D dimensions, and less favourable appraisal of diabetes. When considering age, gender, education, and HbA1c, the main predictors of low HRQOL were BMI (OR 1.35, 95% CI 1.04-1.76, p = 0.025) and ADS score (OR 1.63, 95% CI 1.13-2.35, p = 0.009)., Conclusions: To improve HRQOL, integrated care models should consider interventions that target mental health, obesity prevention, chronic pain management, diabetes education, self-management, and treatment plan personalisation., Competing Interests: Declaration of Competing Interest The authors declare that no conflicts of interest exist., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In Slovenia, primary care is the backbone and gatekeeper to the health care system. During the first months of the COVID-19 pandemic, primary care had to be reorganised to manage suspected COVID-19 patients, safely care for other patients, and manage the consequences of the pandemic., Objectives: To explore the opinions and experiences of Slovenian primary care workers (PCWs) about their confrontation with COVID-19., Methods: In June 2020, we conducted a qualitative study among PCWs in Slovenia. Invited participants ( n  = 42) worked either in primary health care centres or as private contractors and were involved in organising care during the COVID-19 pandemic. The study was conducted using semi-structured online questionnaires. Data was analysed using an inductive-deductive method., Results: Out of 42 invited subjects, 18 participated in the study. The main predefined categories were Information/from decision-makers, Organisation of work, Workforce, Personal protective equipment, Views on decision-making institutions, Stressors that place additional burden on health workers, and Suggestions for improvement (funding, organisation of care). Within these categories, 29 themes emerged., Conclusion: Based on participants' experiences and suggestions, the most important areas to address in similar pandemic situations are clear organisation of work in primary care (adequate funding, staff allocation, distribution of personal protective equipment), psychological solid support for health workers, and effective and timely support from health authorities.

Introduction: Integrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The 'SCale-Up diaBetes and hYpertension care' (SCUBY) Project aims to facilitate the scale-up of integrated care for T2D and HT through the co-creation and implementation of contextualised scale-up roadmaps in Belgium, Cambodia and Slovenia. We hereby describe the plan for the process and scale-up evaluation of the SCUBY Project. The specific goals of the process and scale-up evaluation are to (1) analyse how, and to what extent, the roadmap has been implemented, (2) assess how the differing contexts can influence the implementation process of the scale-up strategies and (3) assess the progress of the scale-up., Methods and Analysis: A comprehensive framework was developed to include process and scale-up evaluation embedded in implementation science theory. Key implementation outcomes include acceptability, feasibility, relevance, adaptation, adoption and cost of roadmap activities. A diverse range of predominantly qualitative tools-including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping-were developed to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. The role of context is considered relevant, and barriers and facilitators to scale-up will be continuously assessed., Ethics and Dissemination: Ethical approval has been obtained from the Institutional Review Board (ref. 1323/19) at the Institute of Tropical Medicine (Antwerp, Belgium). The SCUBY Project presents a comprehensive framework to guide the process and scale-up evaluation of complex interventions in different health systems. We describe how implementation outcomes, mechanisms of impact and scale-up outcomes can be a basis to monitor adaptations through a co-creation process and to guide other scale-up interventions making use of knowledge translation and co-creation activities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The aim of this study was to determine the prevalence of malnutrition and the factors associated with malnutrition in a population of family practice non-attenders. This would enable us to recognize the extent of the problem and anticipate the measures needed to improve the current situation., Methods: This was a cross-sectional observational study in a family medicine setting. Participants were adults living in the community (≥18 y of age) who had not visited their chosen family physician in the previous 5 y (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2025 non-attenders. Data were collected by community nurses in the participants' homes. The main outcome measure was the Malnutrition Universal Screening Tool., Results: The sample consisted of 1641 participants (81% response rate). Increased risk for malnutrition was determined in 216 participants (13.2%; 95% confidence interval, 11.6-14.9). The multivariate model showed a significant association of increased risk for malnutrition with age and body mass index interaction (P = 0.022); number of chronic diseases (P = 0.001); poor assessment of current health (P = 0.001); a feelings of loneliness (P <0.001); and increased pain intensity (P = 0.003)., Conclusion: A screening program at the primary health care level could help identify patients at risk for malnutrition early. This could be followed by appropriate nutrition support, which may help to reverse or halt the malnutrition trajectory and the negative outcomes associated with poor nutritional status., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Safety culture describes leader and staff interactions, attitudes, routines, awareness, and practices within an organisation. With this study, we aimed to determine the psychometric properties of the Slovenian-language version of the Safety Attitudes Questionnaire (SAQ) - Short Form in primary health care settings., Methods: This was a cross-sectional study in the largest primary health care in Slovenia. We invited all employees with a leadership role to participate in the study (N = 211). We used the Slovenian-language version of the SAQ - Short Form., Results: There were 154 participants in the final sample (73.0% response rate), of which 136 (88.3%) were women. The mean age of the sample was 46.2 ± 10.0 years. Exploratory factor analysis put forward six factors: 1) Perceptions of Management; 2) Stress recognition; 3) Teamwork Climate; 4) Communication; 5) Safety Climate; 6) Working Conditions and Satisfaction. This model explained 61.7% of the variance of the safety culture in the primary health care setting. The reliability of the whole scale and of the six factors, assessed using Cronbach's alpha, was all above 0.78., Conclusion: The results of our study suggests that the Slovenian-language version of the SAQ - Short Form with six factors could be a reliable and valid tool for measuring the safety culture in the primary health care workers with leadership role In Slovenia. The Slovenian version differed from the original SAQ - Short Form and the majority of other translated versions. Also, the data was from one health centre only and therefore we cannot draw strong conclusions on its external validity.